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目的分析子宫内、外同时妊娠的临床特点、诊断、治疗方法及妊娠结局。方法回顾性分析39例子宫内、外同时妊娠患者临床资料。结果 39例确诊时孕6~(+1)~9~(+2)周,其中37例为体外受精胚胎移植后受孕,2例为自然受孕;20例有腹痛或阴道出血,2例因腹腔出血导致休克,17例无症状;37例经阴道超声确诊,2例于腹腔出血术后确诊;32例输卵管峡部、壶腹部妊娠者行经腹或腹腔镜下输卵管切除术,5例输卵管间质部妊娠行经腹或腹腔镜下宫角楔形切除或切开取胚术,另2例为宫角妊娠,在阴道超声引导下行细针穿刺抽吸减胚术,手术均顺利,术后无并发症;术后失访4例,余35例随访至2015年6月1日,3例正常妊娠中,2例流产,30例足月分娩,其中29例新生儿健康,1例为21-三体综合征患儿。结论体外受精胚胎移植是子宫内、外同时妊娠发生的危险因素,经阴道超声可早期诊断,输卵管为常见异位妊娠部位,早孕期经腹及腹腔镜手术治疗异位妊娠可使宫内妊娠获良好结局,对宫角妊娠可行经宫角楔形切除、切开取胚术和经阴道超声引导下减胎术。
Objective To analyze the clinical features, diagnosis, treatment and pregnancy outcome of intrauterine and external simultaneous pregnancies. Methods Retrospective analysis of 39 cases of intrauterine and external pregnancy in patients with clinical data. Results 39 cases were diagnosed at 6 ~ (+1) ~ 9 ~ (+2) weeks of pregnancy, of which 37 cases were fertilized after in vitro fertilization embryo transfer and 2 cases were spontaneous conception; 20 cases had abdominal pain or vaginal bleeding and 2 cases had abdominal cavity Hemorrhage led to shock, 17 cases were asymptomatic; 37 cases were diagnosed by transvaginal ultrasound, 2 cases were diagnosed after peritoneal hemorrhage; 32 cases of tubal isthmus, ampulla of pregnancy by abdominal or laparoscopic tubal resection, 5 cases of tubal interstitial Pregnancy by abdominal or laparoscopic wedge resection or incision and embryo surgery, and the other 2 cases of uterine horn pregnancy, guided by vaginal ultrasound fine needle aspiration ablation surgery, surgery were smooth, no complications after surgery; Four patients were lost to follow-up, and 35 patients were followed up until June 1, 2015. Among the three normal pregnancies, 2 were aborted and 30 were given full-term labor. Among them, 29 were neonatal and 1 was trisomy 21 Children with sign. Conclusion In vitro fertilization embryo transfer is a risk factor for simultaneous intrauterine and extrauterine pregnancy. Transvaginal ultrasound can be used for early diagnosis and tubal ectopic pregnancy site. In the first trimester, transabdominal and laparoscopic surgery for ectopic pregnancy can result in intrauterine pregnancy Good outcome, the feasibility of Gongguanyingguanying wedge resection, removal of embryo surgery and transvaginal ultrasound-guided abortion.